Expansion
Examine the gland, then the status, then the complications
Expansion
The gland
- Inspect from the front, then with swallowing (a thyroid mass moves up) and with tongue protrusion (a thyroglossal cyst moves up)
- Palpate from behind: size, symmetry, nodularity, consistency, tenderness, mobility, and the lower border, since retrosternal extension makes it impalpable
- Percuss the sternum for retrosternal extension
- Auscultate for a bruit, which indicates increased vascularity in Graves disease
- Lymph nodes, and Pemberton’s sign for thoracic inlet obstruction
Hyperthyroid
Heat intolerance, weight loss with increased appetite, sweating, diarrhoea, irritability, oligomenorrhoea; tachycardia, atrial fibrillation, warm moist palms, fine tremor, lid lag and lid retraction, brisk reflexes, proximal myopathy.
Hypothyroid
Cold intolerance, weight gain, constipation, lethargy, menorrhagia, hoarse voice; bradycardia, dry coarse skin, loss of the outer third of the eyebrow, periorbital puffiness, slow relaxing reflexes, carpal tunnel syndrome, non-pitting oedema.
Signs specific to Graves disease, present regardless of treated status:
- Thyroid eye disease: exophthalmos, proptosis, chemosis, ophthalmoplegia
- Pretibial myxoedema
- Thyroid acropachy
Lid lag occurs in any cause of thyrotoxicosis; proptosis occurs only in Graves.